Abstract
Effect of the temporary arteriovenous fistula on venous reconstruction for stasis syndrome of the lower extremity was studied experimentally and clinically. The canine iliac vein was replaced with an autogenous vein graft in which the intimal surface was roughened by scrubbing with sponge. A temporary arteriovenous fistula which was closed surgically three or four weeks later was created between the femoral vessels. The patency rate for twenty-one grafts was 80.9 per cent for one to thirty-six weeks (mean 8 weeks), in contrast to complete failure in the control group in which no arteriovenous fistula was created. Adequate healing of the luminal surface of the grafts were experimentally demonstrated by light microscopic examination and en face silver staining of the endothel-like cells with the aid of patent arteriovenous fistula for three weeks.
This procedure was clinically applied in four patients with stasis syndrome of the lowere extremities. Good function of the reconstructed venous segments in three of four patients was observed for the last 3 to 8 years after the operations. A looping technique using 2-0 monfilament nylon around the fistula devised by us was very helpful to make easy the shunt closure later. Open endvenecoomy with a temporary arteriovenous fistula is believed to be an acceptable approach for segmental chronic occlusive lesion in the iliac vein.
Similar content being viewed by others
References
Aschberg, S., Ankarcrona, H., Bergstand, O. and Björkhalm, M.: Temporary arteriovenous shunt to dilate saphenous crossover graft and maintain graft patency,Acta Chir. Scand. 142: 585–587, 1976.
Brandham, R. R. and Buxton, J. T.: Thrombectomy for acute ilio-femoral venous thrombosis,Surg. Gynec. Obstet., 119: 1271–1275, 1964.
Bryant, A. F. Jr., Lazenby, W. D. and Howard, J. M.: Experimental replacement of short segment of veins,A.M.A. Arch. Surg. 76: 289–293, 1958.
Dale, W. A. and Scott, H. W.: Grafts of the venous system,Surgery, 53: 52–74, 1963.
DeWeese, J. A., Jones, T. I., Lyon, J. and Dale, W. A.: Evaluation of thrombectomy in the management of iliofemoral venous thrombosis,Surgery 47: 140–159, 1960.
DeWeese, J. A.: Thrombectomy for acute iliofemoral venous thrombosis,J. Cardiovasc. Surg. 5: 703–712, 1964.
Haller, J. A. Jr.: Thrombectomy for acute iliofemoral venous thrombosis in the postpartum period,Surg. Gynec. Obstet. 112: 75–81, 1961.
Holt, M. H. and Lewis, F. J.: Experimental grafts of the superior vena cava with temporary arteriovenous shunts,J Thorac. Cardiovasc. Surg. 49: 818–823, 1965.
Johnson, V. and Eiseman, B.: Evaluation of arteriovenous shunt to obtain patency of venous autograft,Am. J. Surg. 118: 915–920, 1969.
Kusaba, A.: Clinical results of autogenous vein grafts for venous occlusive diseases,J. Jap. Coll. Angiol. 10: 191–194, 1970 (in Japanese).
Levin, P. M., Rich, N. M., Hutton, J. E. Jr., Barker, W. F. and Zeller, J. A.: Role of arteriovenous shunt in venous reconstruction,Am. J. Surg. 122: 183–191, 1971.
Palma, E. C. and Esperon, R.: Vein transplants and grafts in the surgical treatment of the postphlebitic syndrome,J. Cardiovasc. Surg. 1: 94–107, 1960.
Ross, J. V., Baggenstoss, A. H. and Juergens, J. L.: Gangrene of lower extremity secondary to extensive venous occlusion,Circulation, 24: 549–556, 1961.
Sakaguchi, S., Ishitobi, K., Kameda, T. and Nishibori, F.: Phlebothrombosis and its squelae: Pathophysiology and surgical treatment,J. Jap. Coll. Angiol. 11: 103–109, 1971 (in Japanese).
Scheinin, T. M. and Jude, J. R.: Experimental replacement of the superior vena cava: Effect of temporary increase in blood flow,J. Thorac. Cardiovasc. Surg., 48: 781–789, 1964.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kusaba, A., Makino, J., Kamori, M. et al. Venous reconstruction by endvenectomy with temporary arteriovenous fistula for stasis syndrome of lower extremity: Experimental and clinical studies. The Japanese Journal of Surgery 10, 121–129 (1980). https://doi.org/10.1007/BF02468676
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02468676